Paul Soloff, M.D.

An fMRI Study of Affect Arousal and Cognitive Control in Suicidal Subjects with Borderline Personality Disorder

Abstract: Suicidal patients are characterized by deficits in emotion regulation and executive cognitive function, increased vulnerability for impulsive and aggressive behaviors, structural and metabolic brain abnormalities in areas of prefrontal cortex. These deficits appear highly interrelated and may constitute a neurobiological diathesis to suicidal behavior independent of diagnoses. This study will use functional Magnetic Resonance Imaging (fMRI) in subjects with borderline personality disorder and histories of medically significant suicide attempts to define the neural basis by which affective arousal impairs executive cognitive functions and contributes to impulsive suicidal behavior. Twenty female borderline personality disorder subjects, 10 attempters and 10 non-attempters, will be compared to 10 control subjects on three fMRI cognitive performance tasks, each incorporating emotional stimuli (positive, negative or neutral faces or pictures). The cognitive tasks engage the function of brain regions previously shown to be structurally or metabolically abnormal in borderline personality disorder. We will assess the degree to which affective arousal impairs cognitive task performance, and compare patterns of neural activation reflecting excitation and inhibition in suicidal and non-suicidal borderline personality disorder subjects with healthy control subjects. This study will characterize the neurobiological basis of the borderline patient’s failure of inhibitory control over emotion and behavior at times of affective stress and contrast subjects with medically significant suicide attempts with non-attempters and control subjects. Identification of dysfunctional brain networks using readily available fMRI techniques may provide a biological marker for patients at highest risk for impulsive suicidal.